Stage 6?

A difficult visit last night.  Started with a series of "oh, shit" moments.  When I got there he was sitting on his bed with his pants off.  He'd wet his underpants, and D was trying to get him to take off the wet pair and put on a dry one.  He got angry and agitated -- didn't want to remove the wet pair.  "No, that's not the way we do it -- we've never done it that way."  He kept trying to put the dry pair over the wet pair.  I finally told her to let him be right.  Later on there might be an opportunity to swap out the wet pair, but right then it was better to have him uncomfortable than upset.  So we let him go ahead.  Then he grabbed a pair of pants and said he needed his socks.  D pointed out that he was already wearing his socks.  He reached for them and felt them -- then forgot what the pants were and what to do with them.  After that, ten more minutes of agitation while he put on a pair of outdoor shoes, figured out how to use his belt, and filled his pockets with Kleenex.

Then a long tour through his appointment book.  It goes back to 2001 and he only uses a page in the back where we've written down the phone numbers he needs.  But he'd discovered the rest of the book, and had to show us all the upfront pages -- their numbers, what was written on them, and the one odd place where there was a picture instead of writing.  Then there was more writing...  Interestingly, he seemed to read the page numbers and some of the text better than he's been able to in the recent past.  Don't know what that signifies.

Then he led us on a tour of the apartment -- had to show us where everything was.  We had to stop off at the seashell jar while he explained it again.  (Side note: someone sent me a link to this.  Maybe I'll buy him one).  Then he took us to the kitchen and showed us the food and the appliances.  As this went on it seemed to get more purposeful -- like he was trying to orient us (and maybe also himself).  For a moment or two I thought it had a valedictory quality (here's how to find everything while I'm gone) but I'm not sure that's accurate.  More likely he wanted us (and himself) to feel at home.

He got quieter after that.  The house tour took a lot of energy and wiped him out.  He had a very light dinner, then stretched out on his bed, looked at the Mets game without too much focus, and fell asleep for most of the rest of the night.

So where are we?  Still not sure.  As noted yesterday, this could all be drug reaction, or a reaction to the surgery.  Or it could be the result of the anesthesia.  Or irreversible damage separate from the anesthesia.  It's obviously hard to sort out.  Longyears, a regular reader, suggested a few avenues to explore.  A change in nutrition might mitigate some of the more severe confusion -- worth a try.  Longyears also thought it might also be productive to explore the geography of some of the cognitive damage.  The incident of the fingers, for example: that might indicate a loss of proprioception, which would suggest frontotemporal involvement.  On the other hand, it could be visual disorientation -- he's had plenty of that recently.  Or maybe it's both at once.

If you'd asked me last night, I would have told you he was at Stage 6.  But E just called and said she thought he was doing somewhat better this morning.  I talked to him briefly and he sounded a bit more oriented.  Still at 5?  Halfway to 6?  Time will tell.

I'm heading back to DC tonight.  I haven't been through what he's been through, but I've been through something, and I'm grateful that I'll be able to regroup.  I'll do the nightly phone conversations, we'll cycle him through a visit to the surgeon next Tuesday, and then I'll be able to take a fresh look when I see him as usual next Wednesday night.  Updates before then if things happen, which, experience indicates, they probably will.

Comments

[julie]

Hi Alan, sounds like things continue like they do. I'm going to bet that most of what you describe happening right now is worse because of the anesthesia. My mom, who is 81, had a four hour surgery and had a terrible time just waking up and then she was a different person in her personality for at least a month. She was still showing effects 6 months later. I'm also going to guess that some of what you are seeing has been there to a degree for some time and since everyone is watching so closely, it is now too obvious not to see. That doesn't mean he won't come around as he recovers, just that when you are with a person over a longer time frame, you see things.
I'm really glad to hear he came through this physically so well, and you too for that matter.

[Alan G. Ampolsk]

Thanks. I'm inclined to agree that it's related to the anesthesia. And -- per my new post -- I don't think he's going to come back all the way. The pattern has been that he regains a little ground but not all of it. That makes sense because -- as you suggest -- the anesthesia is aggravating a set of problems that are already there. So the result is a faster decline, but it was going to be a decline in any case. Still, if he recovers even slightly, that gives me more time to plan, which is a good thing. I'll take what I can get.